Healthcare Provider Details

I. General information

NPI: 1891109633
Provider Name (Legal Business Name): ERIN ELIZABETH MOSELLEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 MONTGOMERY RD SUITE 120
CINCINNATI OH
45236-4283
US

IV. Provider business mailing address

PO BOX 631662
CINCINNATI OH
45263-1662
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5999
  • Fax: 513-791-4567
Mailing address:
  • Phone: 859-344-2079
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: